Introduction: On the road to recovery

The NHS experienced one of its most challenging years in
2004/05. There has been very substantial public investment
in the service to improve the standards and timeliness of
care. In return for this investment, the performance of the
NHS has to improve to meet the changing expectations of
patients and the population. In West Herts the pressures
have been intensified by a long history of financial and
organisational problems.David
Law, Chief Executive and Robin Douglas, Acting Chairman

As a Trust we have needed to:

improve performance against key standards, as with the
work we have done in reducing waiting times in A&E and for planned
surgery and outpatients

continue to develop and improve services, as we have
done with investment in new Dermatology and Gastroenterology facilities at
Watford and Hemel Hempstead respectively

start to plan for major changes to the way acute
health care is organised in West Hertfordshire, as part of the Investing in Your
Health programme

The key objective for the Trust must continue to be the
efficient provision of high quality services to people who
need acute health care. We have been privileged to witness
many examples of superb clinical care within this
organisation.

The turnaround of performance in A&E has been
outstanding and shows the importance of strong clinical
leadership and multidisciplinary working. We have recently
celebrated success in nursing and midwifery, and there are
many other examples of excellence in the medical, therapy
and other clinical professions.

We will continue to focus on the quality of treatment and
care that we offer. We achieved a one star rating as a Trust
which was a deserved improvement on last year. We were
pleased to have the progress we have made acknowledged.
Whilst our clinical services are good and score well on the
relevant league tables, we let ourselves down on the star
ratings because we are not so good on some of the measures
which are important to patients - infection control, waiting
times for cancer treatment, the cleanliness of our
facilities, cancelled operations and so on.

In future these issues will, rightly, be of increasing
importance and the health of the organisation will depend on
how well we perform. It is a cliché to refer to staff as
our greatest asset. But it is true. Motivated, dedicated
staff, with the right clinical skills and with the right
managerial skills are key to the success of the organisation
and to the well-being of the patient. We will put in place a
programme of development to support staff and improve
services.

We are confident that we can turn the organisation around
and redevelop our sites so that we become the employer of
choice as well as the provider of choice for local people.
The Trust Executive, which now has strong clinical
representation on it, will provide leadership.

The challenge for all of us is to work well together,
concentrating on patients’ needs and the efficiency of our
services. We are at a crossroads as an organisation and the
next twelve months will be critical. We have great
challenges to face but we have every confidence that we can
succeed.

Jessie Winyard, Chair,
Patients’ Panel

The past year has been difficult for the Trust and for the
staff as a whole. There are still many hurdles to cross but
we are on the right road again. We are not the only Trust
going through a rough time but already we have made inroads
by regaining one star in the 2004/05 performance ratings,
although from a patient point of view the way in which staff
have pulled together, in my view, has made you all five star
status.

We, the Patients’ Panel, appreciate everything that is
being done – the new Dermatology Units at Watford and
Hemel hospitals, the new Breast Centralisation Unit at St
Albans City Hospital, which will open in the autumn and the
new Endoscopy suite that will shortly be opening at Watford
General Hospital.

This year’s ‘Celebrating our Success’ Conference, held
in July, was so uplifting. We saw the dedication of staff in
their various fields and learnt so much. So thank you to a
great team, whatever part you play, from a Patients’ Panel
who are also your patients and critical friends.

Dr Sarah Hill, Associate Medical
Director, Consultant Development

It's been an exciting year with achievements and some
challenges. For the first time, we achieved 100% compliance
with consultant appraisal for the year 04/05. We are now
awaiting guidance from the GMC regarding the link between
appraisal and revalidation. Our challenge will be to prepare
all the doctors working within the Trust for revalidation
expected in 2006.

Our second success was the transfer of over 70% of
consultants onto the new consultant contract. This means
that the Trust is now in a strong position to adapt to
future changes within the NHS.

We have established an induction programme designed for new
consultants, introducing them to key personnel within the
Trust, PCTs and community.

The British Association of Medical Managers (BAMM) are
supporting this programme, offering an insight for new
consultants into management methods.

Dr Ian Barrison, Associate
Medical Director, Postgraduate Education

The past twelve months have been both challenging and
successful for Postgraduate Education. The Trust has begun
the Foundation Year 1 programme, with an additional seven
PRHO posts and excellent rotations with the University
College London and Imperial College. The Foundation Year 2
programme is under development and the Trust has achieved
funding for innovative posts linked with Public Health and
Palliative Care.

The February and August induction days were well received
and passed a recent CNST inspection. We have continued to
use a rolling induction programme to complement the main
Induction days and to ensure that all mandatory training
sessions are covered.

We continue to accept an increased number of medical
students from the London medical schools. The Undergraduate
Administrator has successfully set up a rolling teaching
programme for Medical Students that incorporates clinical
skills and the University noted this as an area of good
practice during a recent visit.

The Clinical Skills Laboratory has seen an increase in
its use during the past twelve months with both
Undergraduates and Postgraduates using it on a weekly basis.

Clinical Governance is now well established within the
Clinical Divisions and sub specialties. Emphasis has been on
the patient’s experience and satisfaction, communication
with patients and relatives, and getting the basics right
(record keeping, food and nutrition, privacy and dignity,
communications, hospital cleanliness).

Promotion and monitoring of the use of national clinical
guidance throughout the Trust has been successful, with 85%
full or partial compliance with NICE guidelines.
Collaborations with primary care have increased to promote
clinical effectiveness standards and to share information on
best practice.

A new R&D consortium has been established incorporating
East and North Herts NHS Trust, hosted by West Hertfordshire
Hospitals NHS Trust, with a strategy to promote and further
develop research in Hertfordshire. Response criteria for
management of ovarian cancer developed by West Hertfordshire
Hospitals NHS Trust have been adopted internationally.

National and mandatory audits have been completed and
delivered on time by Clinical Audit. Clinical Divisions
carry out regular audits of guidelines and priority projects
as part of an agreed audit program.

Alfa Sa’adu, Deputy Medical
Director

Shorter waiting times in our A&E departments,
independent acknowledgment that we have an excellent stroke
service and gaining a star in the performance ratings, form,
for me, the three major highlights for this past year.

The Watford Stroke Unit was recently ranked 15 out of 246
hospitals in the ‘National Sentinel Audit for Stroke
2004’ commissioned by the Healthcare Commission. This
independent audit has given us the chance to compare our
performance with every other organisation caring for stroke.
It is a tribute to the huge amount of work by everyone
involved that we came eighth out of all District General
Hospitals and 10 most improved Trusts since the last audit
in 2002. This will motivate us all to stay on top, and help
attract new members to the team.

The Trust is now consistently meeting the target to see,
treat and admit or discharge 98% or more patients attending
A&E within four hours. This is not easy and I see first
hand how hard our staff work to make reach this challenging
target.

Hearing from patients, their relatives and carers is so
important. West Hertfordshire Hospitals NHS Trust is lucky
to have the ‘critical friendship’ of both the Patient
and Public Involvement Forum and the Patients’ Panel, and
an army of Patient Representatives. Thank you.